Labor of Love or Extreme Birth?

Now that I'm catching up on reviews, I thought I should spread the word about New York midwife-extraordinaire, Cara Muhlhahn's memoir, Labour of Love

For those of you that saw Ricki Lake's documentary Business of Being Born, you will be familiar with Muhlhahn's as a selection of her homebirths were featured in the film. The book is a rich recounting of Cara's 30 years of experience as a midwife - she recounts her formative adolescent experiences, the homebirth of her own son and a selection of stories from the 700+ babies that she has delivered over the years.

Watching Muhlhahn in action in BOBB, for me, was one of the highlights of the film. Sensitively attending to each woman's concerns, providing unconditional and unconventional support and reassuring women at their most vulnerable was not only heartwarming but profoundly moving.

Nevertheless, in New York Magazine feature, Muhlhahn is painted as a renegade in the homebirth movement, as 'fearless' to the point in which women's lives are at risk. Her self-assuredness and confidence from years of experience is positioned as hubris and perhaps arrogant. Homebirth is positioned as 'extreme' and merely a growing 'trend' among middle-class women who have taken to birth at home like the latest Gucci handbag and those women that opt to do so as selfish and perhaps a bit clueless. This is quite a divergence from the sensitive and thoughtful portrait painted of Muhlhahn by Ricki Lake and Abby Epstein in their documentary and by Muhlhahn herself in her memoir.

Has anyone else read the book? Thoughts on the movie or the article?

A tour de force of birth

I finally saw On The Business of Being Born (OTBOBB). Ricki Lake and Abby Epstein have created a film that will make you experience what feels like a lifetime of emotions in the short span of 85 minutes. Navigating the streets of New York with a lone midwife on a mission to bring birth back into the home, OTBOBB draws on the experiences of pregnant women as they navigate the bureacracy of the American maternity system. In between providing a brief history of medicalised birth, the most profound and ultimately moving feature of this film is the up close and very personal view of birth---something which most women have never witnessed until their own. Babies are born throughout this film in some of the most humbling and beautiful footage I have seen on the subject to date.

Whilst the American and Australian maternity are relatively similar, the glaring lack of midwives in the American system is where the cracks in the foundation begin to show. The overwhelming use of 'pit' or pitocin in New York hospitals where an astounding 90% of births are induced is the trigger for the cascade of interventions to which American women are subject in contemporary maternity wards.

Thus, it is easy to see how the production of oxytocin, the naturally occurring hormone in women's bodies that triggers birth and is also described as a 'love' hormone to help with bonding when the baby is born, is stifled in this environment. The use of 'pit' or syntocinin (in Australia) is a synthetic form of oxytocin. However, when women are induced with this synthetic form of oxytocin, contractions are much stronger. When contractions are stronger, there is more pain and it is no wonder that the obstetric residents in certain NY hospitals were shoving epidurals in womens' spines as soon as the pain started to increase. However, epidurals slow labour right down. Ironic, eh? Women are induced to speed labour up in order to keep more beds open and the turn-over high in American hospitals. Yet, induction = pain = epidural. This slows labour down and puts baby at a higher risk for complications. The naturally occuring oxytocin? Replaced with adrenalin, the 'fight-or-flight' hormone which is produced when women are afraid or feel unsafe. No natural endorphins, no oxytocin. Just fear, shame and 'failure'. And you know what happens next? Caesarean. NY state hospitals have some of the highest caesar rates in America, hovering at 46%. Birth centres are closing faster every day due to the daily battles against insurance companies, rising costs and the inability to compete with hospitals. Homebirths? Only 1% of all births in America.

OTBOBB portrays modern birth as a battle being waged on women's bodies. There are no 'choices' when birth is left in the hands of 'experts' and midwives are nowhere to be found. Australian women are lucky in the respect that 'normal' birth is largely left up to midwives. However, the intervention rate is still extremely high in Australia and there is a growing lack of trained midwives available to all of the women that need them. Hospitals are increasingly reluctant to hire midwives because it is a competition for their obstetric business. Moreover, private midwifery care is rarely covered by insurance but this is most likely changing.

I had chills watching this movie. There were times when I felt so angry watching women in hospital being moved around like cattle, being told they had to be induced without any information provided to them as to the risks of the procedures being performed on their bodies. Informed consent is pretty much non-existent in the American system. America has one of the worst infant and maternal mortality rates in the world despite being one of the richest countries. Why? Birth has been taken out of the hands of women and their bodies are used to line the pockets of insurance companies, hospitals and obstetricians who don't care about the process but only about the product. As long as a baby comes out alive, it doesn't matter how it got there.

YOU MUST SEE THIS MOVIE.

NOW.

YOUR LIFE DEPENDS ON IT.

Home delivery is apparently just for pizza

The American College of Obstetricians and Gynecologists has just released a statement on their anti-homebirth position as a means of quietly confronting the 'popularity' of Ricki Lake's On The Business of Being Born. As can be expected from a group of highly paid doctors working in hospitals, ACOG states the most ideal model for birth is inevitably in a hospital with an obstetrician where risk can be managed. They say:

"Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby."

Not only does the ACOG discount all of the legitimate medical literature arguing for the benefits of homebirth, the idea that millions of American women are jumping on the homebirth bandwagon from seeing a movie is insane. If only this was the case! Despite the seeming popular appeal of homebirth, the fact is that most American women (about 99%) still give birth in hospitals and only about 1% of all births are 'alternative' with midwives, in birth centres or at home. Moreover, increasingly homebirth and midwifery are becoming harder to access in a number of states. A bill has passed through the Utah legislature that seeks to ban homebirths altogether and is just another way in which women's rights are being curtailed, providing fodder for the black market of midwives that is thriving in states across America.

According to ACOG, birth is just an emergency waiting to happen. It is a frightening proposition that this medical body says that they support a woman's right to 'choose' how she will give birth but implicit in that statement is the suggestion that if you decide to avoid intervention you are irresponsible. This raises very serious questions about what is considered to be 'high-risk'; increasingly having a big baby, a premature baby or a previous caesar are grounds for intervention whereas earlier they would not.

What's worse is that the high caesarean rate in America is attributed to pregnant women being too overweight and too old; ACOG places no responsibility for the 45% rate of caesars on obstetricians themselves. As Jennifer Block so convincingly argues in Pushed, the reality of hospital birth today is contingent on doctor's wanting short shifts, fast births and women to just shut up about it. ACOG speaks of midwives as if they are the devil's advocates and categorically state that as a result of their lack of comparable skills and inability to address 'high-risk' pregnancies, midwives are not to be trusted. What about all of the literature suggesting that birth with a midwife actually lowers caesarean rates?

In a nutshell, ACOG says in no uncertain terms: "Choosing to deliver a baby at home... is to place the processof giving birth over the goal of having a healthy baby." There is no 'right' way to give birth and to suggest that women are irresponsible for moving away from the medical model is an appalling abuse of biomedical power.

Source: http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
http://www.kcpw.org/article/5301

The Business of Being Born screening this Sunday

Due to such high demand, Ricki Lake's documentary, The Business of Being Born, is back in Melbourne this Sunday at the Hawthorn Town Hall. Birth attendant and local legend, Rhea Dempsey will be leading a discussion following the 85 minute film. Tickets are $25 and a portion of proceeds go to The BellyBelly Pregnancy Centre opening this year.

To see the trailer and buy your ticket, go here:http://www.bellybelly.com.au/movie

Sneak preview: Ricki Lake's 'The Business of Being Born'

I am so disappointed I will miss the opportuntiy to see this film because I'm off to the US next week. If you are in Melbourne and are interested in home birth, book your place now!

Presented by Maternity Coalition Victoria
in association with the La Trobe University School of Social Sciences, La Trobe University School of Nursing and Midwifery and the Mother and Child Health Research Centre.

A documentary film by Ricki Lake, directed by Abby Epstein

Followed by panel/audience discussion on

The Relevance of the film to ‘future directions’ for Victorian maternity care

Thursday 6th December 2007
7pm for a 7:30 sharp start
Screening is approx 1 ½ hours, followed by the discussion panel

La Trobe University, Bundoora
Western Lecture Theatre (WLT) 1.
Parking available in Car park 2,
number 86 tram from the City

Cost: $10 single, $15 family. Payable at the door

BOOKINGS ESSENTIAL:
RSVP BOBB.melbourne@maternitycoalition.org.au

Light refreshments provided on entry.
Babes in arms welcome.

Sources: http://www.thebusinessofbeingborn.com/
http://www.maternitycoalition.org.au/

ricki lake homebirth doco

Remember Ricki Lake? Gosh, how many afternoons of my primary school years were spent in front of the boob tube watching The Ricki Lake Show? Well, according to the Huffington Post, Ricki is premiering her documentary, On The Business of Being Born, at the Tribeca Film Festival. The film is inspired by her own very different birth experiences and even shows Lake birthing her son Owen in the tub. Here is a snippet of the interview:

Why did you want to produce this film?

I wanted to make this movie after my two very different birth experiences with my children. I felt like I had an opportunity to explore and question birthing practices in this country and perhaps be an advocate for mothers' rights and better maternity care

How did your personal birth experiences influence you?

After the birth of my sons, particularly my home birth with my second son, I thought I wanted to become a midwife. Then I looked at all the years of schooling and training that I would have to do and felt that the time could be better spent doing a documentary on the subject of birth.

How intimate does the film get?

I am naked at 195 pounds giving birth in my own bathtub. It can't get any more intimate than that!

Read the rest of the interview here:

http://www.huffingtonpost.com/ricki-lake/ricki-lake-on-the-bus_b_46002.html

Go Ricki! Go Ricki!